Written evidence submitted by Professor Alexandra Johnstone and Dr Hannah Greatwood (PHS0069)

TOPIC: OBESITY, DIET and HEALTH INEQUALITIES

Submitted by: Prof. Alexandra Johnstone (University of Aberdeen, Rowett Institute) and Dr Hannah Greatwood (Leeds Beckett University), on behalf of the Food Insecurity and Obesity (FIO Food*) project team, funded through the UKRI’s Transforming UK Food Systems Strategic Priority Fund**. The existing FIO Food Project aims to provide actionable evidence for policy on retail strategies to address dietary inequalities in people living with obesity and food insecurity, to support environmentally sustainable and healthier food choices in the UK food system. The multi-disciplinary team employ a food systems and collaborative approach with co-development as a key feature, through four inter-linked work packages, to combine our knowledge of large-scale population data with an understanding of lived experiences of food shopping for people living with obesity and food insecurity, to develop solutions to improve sustainable and healthier food choices.

Why should the Health and Social Care Committee consider this issue as part of its Prevention inquiry? The most recent Health Survey for England estimates that 25.9% of adults in England are living with obesity and a further 37.9% are living with overweight1. Current UK Government Policy has failed to achieve substantive change in obesity levels. Theis and White2 have highlighted that even though the UK government have published 14 separate obesity strategies in England between 1992 to 2020, but the prevalence of obesity has increased over this period. In addition to reducing quality of life3 and life expectancy4, obesity is associated with an increased risk of several major non-communicable diseases, including type 2 diabetes, coronary heart disease, stroke, and several cancers5–7, as well as reduced psychological well-being8. In the most deprived areas in England, prevalence of obesity or being overweight is 9 percentage points higher than in the least deprived areas1.

Why the Committee should look at it now: in particular, whether there is an opportunity for it to add value to existing research and evidence. The current UK economic climate has led to a cost-of-living and energy crisis, which is disproportionately affecting poorer households. Increased cost of food is likely to be intensifying existing diet challenges, including, food insecurity9. Food insecurity, defined by the Trussell Trust “as a household-level economic and social condition of limited or uncertain access to adequate food”10 can lead to health disparities11. Nutritionally poor, often ultra-processed, energy-dense foods are notoriously cheaper and more readily available9, making the purchase of healthy, nutritious food challenging. Research suggests that it may be harder for people living with obesity and food insecurity to reduce their weight, compared to individuals who are food-secure12,13. In context, for those on low incomes (the poorest fifth of UK households) need to spend 43% of their disposable income on food, to consume a healthy diet according to the Eatwell guidelines, which compares to just 10% for the highest-income fifth9.

Why this area would benefit from scrutiny. In a recent (29th April to 2nd May 2022) poll by YouGov of 2001 UK adults, 55% (1110) reported a negative impact[1] on their health from the rising cost of living. Of these, 78% (870) attributed this to the rising cost of food14. The National Food Strategy for England15 recognised the complex issues in the UK, where obesity and diet inequalities exist. However, a key challenge facing people living with obesity is the ability to afford a healthy, balanced diet. Dimbleby’s Food Strategy Policy review paper restates previous government targets, to halve childhood obesity, to reduce the healthy life expectancy gap, to add five years to healthy life expectancy. However, doubt has already been cast on whether these targets are achievable2,16, especially given the increasing cost of food and numbers of people identifying as food insecure14. While there is an acceptance that finding a solution to obesity is “a shared responsibility”, the strategy policy paper perpetuates the notion that individual consumers “empowered with better information” will make healthier choices17

Why the Government needs to take action in this area. It is estimated that the NHS spent £6.1 billion on overweight and obesity-related ill-health in 2014 to 2015, which is estimated to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year18. However, tackling the rising obesity level is complex, partly due to the range of factors that influence body weight19. Like many public health issues, it requires better access to treatment, improved food quality and nutritional education, reduced prevalence of aggressive promotions and advertising which encourage people to eat foods high in fat, sugar and salt, and of course sufficient household budgets to afford a healthier diet20. The Transforming the UK Food System for Health People and a Healthy Environment Programme, funded through UKRI, has initiated research projects to change the UK food system but there is scope for expanding on this, given the continued economic uncertainty, cost of living crisis and the increasing prevalence of obesity within the UK. Failure to address the increasing prevalence of people living with obesity, with food insecurity, will result in the widening of the health inequalities gap and increase financial pressure on the NHS service.

1              NHS Digital,. Health Survey for England, 2021 part 1. NDRS. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021 (accessed Feb 1, 2023).

2              Theis DRZ, White M. Is Obesity Policy in England Fit for Purpose? Analysis of Government Strategies and Policies, 1992-2020. Milbank Q 2021; 99: 126–70.

3              Sigit FS, de Mutsert R, Lamb HJ, Meuleman Y, Kaptein AA. Illness perceptions and health-related quality of life in individuals with overweight and obesity. Int J Obes 2022; 46: 417–26.

4              Lung T, Jan S, Tan EJ, Killedar A, Hayes A. Impact of overweight, obesity and severe obesity on life expectancy of Australian adults. Int J Obes 2019; 43: 782–9.

5              Riaz H, Khan MS, Siddiqi TJ, et al. Association Between Obesity and Cardiovascular Outcomes: A Systematic Review and Meta-analysis of Mendelian Randomization Studies. JAMA Netw Open 2018; 1: e183788.

6              Avgerinos KI, Spyrou N, Mantzoros CS, Dalamaga M. Obesity and cancer risk: Emerging biological mechanisms and perspectives. Metabolism 2019; 92: 121–35.

7              Nyberg ST, Batty GD, Pentti J, et al. Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study. The Lancet Public Health 2018; 3: e490–7.

8              Amiri S, Behnezhad S. Obesity and anxiety symptoms: a systematic review and meta-analysis. Neuropsychiatr 2019; 33: 72–89.

9              The Broken Plate 2022 | Food Foundation. 2022. https://foodfoundation.org.uk/publication/broken-plate-2022 (accessed Feb 1, 2023).

10              Sosenko F, Littlewood M, Bramley G, Fitzpatrick S, Blenkinsopp J, Wood J. State of Hunger: A study of poverty and food insecurity in the UK. The Trussell Trust, 2019.

11              Health Equity in England: The Marmot Review 10 Years On - The Health Foundation. https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on (accessed Feb 1, 2023).

12              Brown AGM, Esposito LE, Fisher RA, Nicastro HL, Tabor DC, Walker JR. Food insecurity and obesity: research gaps, opportunities, and challenges. Transl Behav Med 2019; 9: 980–7.

13              Morales ME, Berkowitz SA. The Relationship between Food Insecurity, Dietary Patterns, and Obesity. Curr Nutr Rep 2016; 5: 54–60.

14              Iacobucci G. Rising cost of living is damaging people’s health, says royal college. BMJ 2022; 377: o1231.

15              National food strategy for England. GOV.UK. 2021; published online July 15. https://www.gov.uk/government/publications/national-food-strategy-for-england (accessed Feb 1, 2023).

16              Marteau TM, White M, Rutter H, et al. Increasing healthy life expectancy equitably in England by 5 years by 2035: could it be achieved? Lancet 2019; 393: 2571–3.

17              Doherty B, Jackson P, Poppy GM, Wagstaff C, White M. UK government food strategy lacks ambition to achieve transformative food system change. Nat Food 2022; 3: 481–2.

18              Health matters: obesity and the food environment. GOV.UK. https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment--2 (accessed Feb 1, 2023).

19              Reducing obesity: obesity system map. GOV.UK. https://www.gov.uk/government/publications/reducing-obesity-obesity-system-map (accessed Feb 1, 2023).

20              Goddard A. The cost of living crisis is another reminder that our health is shaped by our environment. BMJ 2022; 377: o1343.

February 2023